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Fundamentals of Diabetic Wound Care

Diabetes is a chronic medical condition affecting millions of persons of all ages worldwide. A significant proportion of affected persons will develop slow-healing wounds and underlying tissue damage. With a significantly higher risk of undesirable complications like permanent limb deformities and amputations, proper wound care for diabetics is of paramount importance.

Why Do Diabetic Wounds Occur?

Persistently high levels of blood glucose will damage blood vessels supplying oxygenated blood and nutrients to various parts of the body including the extremities. A reduction in blood circulation and impeded tissue perfusion will slow wound healing rates as the materials needed for rapid injury resolution are not reaching wound sites as they should.

Further, white blood cell function is impeded in diabetics. The implications are increased bacterial colonization at wound sites as the body is not able to mount sufficient defenses to fight off invading bacteria. A diabetic wound heavily colonized by pathogenic micro organisms will heal very slowly and often become chronic or non-healing.

Lastly, diabetics with poor glycaemic control will eventually develop peripheral neuropathies characterized by tingling/numbness in their limbs. Reduced sensations in limbs will place affected individuals at a higher risk of getting injured without noticing. The resultant poor wound care will permit extensive damage before wounds are noticed and attended to.  

Diagnosing Diabetic Wounds: Clinical Features

Diabetic wounds often occur most frequently on the lower extremities (legs, and feet) and are therefore usually referred to as diabetic limb/foot wounds.

Symptoms

●       Peripheral neuropathy (paraesthesia,hypoesthesia, hyperesthesia, dysesthesia)

●       Intermittent painful leg and foot cramps usually on climbing an incline

●       Pain in legs even at rest

Signs on PhysicalExamination

●       Dry fissured skin

●       Visible ulcerations on legs and feet

●       Diminished peripheral pulses

●       Obvious evidence of tissue necrosis and gangrene (in advanced cases)

Diagnosing Diabetic Wounds: Investigations

Laboratory and radiological investigations are critical tools in diagnosing diabetic wounds as well as guiding treatment and making a realistic prognosis.

Useful investigative tools include:

●       Peripheral nerve testing

●       Skin and nerve tissue biopsies

●       Ankle-brachial pressure index testing

●       Wound cultures

●       Random and fasting blood glucose testing

●       HbA1C testing

●       Electromyography

●       Nerve conduction studies

●       Computerized tomography scanning

●       Magnetic resonance imaging

●       Doppler ultrasonography

Wound Care for Diabetics: Effective Management Strategies

The management of diabetic wounds is usually a long-term plan developed and implemented by a team of multi-disciplinary wound care professionals. While wound care solutions for each individual should be structured to suit their unique presentation, there are general treatment strategies that can be implemented to optimize wound healing outcomes.

Local Wound Care Solutions

Regularly scheduled wound reviews with debridement, and wound care dressings are crucial to providing an optimal environment for rapid tissue injury resolution. For diabetic limb ulcers and other injuries, daily saline dressings and other appropriate wound care dressings are currently recommended.

Saline dressings maintain a moist wound environment, absorb excess wound exudate and limit bacterial wound colonization. Hydrocolloid dressings will provide significant benefits in dry wounds while alginate and impregnated gauze dressing can manage copiously exudative wounds. Depending on the amount of necrotic tissue noted within and around the wound margins, debridement sessions can be scheduled appropriately.

An advantage of this approach to wound care for diabetics is the flexibility of the interventions. Local wound care can either be received at a long-term care facility or in the comfort of the patients’ homes.

Diet and Lifestyle Modification

Persons with diabetic limb wounds will benefit from changes to the types of food and drinks they consume.Consultation with a dietician who has experience in formulating healthy,nutritious, and tasty meals for diabetics is highly recommended. Meals should include plenty of fruits, vegetables, and whole grains. Foods with high calories and saturated fats should be avoided.

Apart from dietary modification,integrating mild to moderate physical exercises in daily activities is quite beneficial as a wound care strategy. Physical exercise might help improve circulation in some cases increasing oxygenation and nutrient supply to wound sites. Weight loss might also help improve glycaemic control in patients with obesity-related diabetes.

Infection Control with Antibiotics

For slow healing or non-healing diabetic wounds, antibiotic therapy might be needed. Due to their nature, these injuries will provide a welcoming environment for microbial colonization and the onset of soft tissue infection. Empirical or wound culture-guided antibiotic cover should be considered in cases where there are obvious signs of infection.

Strict Glycaemic Control

With a well-established link between poor blood sugar control and slow wound resolution in diabetics, achieving a steady glycaemic state is one of the most crucial wound care solutions to utilize.Optimal levels of blood glucose can be obtained through the consistent use of appropriate doses of insulin injections or oral hypoglycemic medications.Achieving a satisfactory steady-state will reduce the occurrence of new complications whilst enabling faster wound resolution.

Surgical Intervention

Ideally, all patients with diabetic wounds should undergo surgical evaluation by a vascular surgeon and a podiatric surgeon to determine their suitability for extensive debridement, bony or vascular reconstructive surgery, and soft tissue defect correction.

Other Treatment Measures

There are various other treatment options with useful benefits in managing diabetic wounds include:

●       Biologic wound dressing substitutes

●       Topical recombinant growth factors

●       Hyperbaric oxygen therapy

Prevention of Diabetic Limb Complications

Daily self-examination of limbs checking for changes to skin color, temperature, callus formation, and development of ulcers. All abnormal changes should be reported to wound care professionals immediately.

●       Use of protective footwear and avoidance of walking barefoot at all times.

●       Regular follow-up appointments with podiatrists to monitor feet for calluses and ulcerations.

●       Adherence to medication regimens,dietary and lifestyle modifications.

Remote Wound Measurement: An Innovative Approach to Diabetic Wound Care

Achieving optimal outcomes in diabetic wound care requires close and constant monitoring with access to expert advice to wound care professionals. These services are sometimes unavailable to the persons who need them due to location and other constraints. The Wound Pros advanced EHR system is a robust telehealth solution for automatic and accurate wound measurement and automatic generation of documentation for care teams in long-term care facilities.